Moving towards daycase TURP

02 April 2019, Mr Neil Barber - 

Mr Neil Barber is a TUF researcher that is looking to make treatment for BPH, one of urology’s most common conditions, cheaper for the NHS and better for patients.

What is BPH and how is it treated?

Benign Prostatic Hyperplasia (BPH – an enlarged prostate) is one of the most common urological conditions, with around 60% of men over 60 encountering symptoms such as difficulty peeing, an urgent need to pee, getting up in the night to use the toilet, and not being able to completely empty the bladder when peeing.

Up until now, one of the most common treatments has been a surgical operation known as TURP, an operation that has required an average of more than 2 nights in hospital after the operation. In an era when the NHS is driving towards daycase surgery for elective procedures, urologists are facing encouragement to switch to alternative procedures to decrease bed occupancy and save the NHS money.

However, many urologists are uncomfortable with the concept of taking up a different procedure and enduring the inevitable learning curve and, as a result, TURP, be it mono-polar or bipolar (TURiS), remains the most commonly offered and performed surgical solution for this group of men.

Whilst sporadic departments do deliver TURiS as a daycase procedure, could there be simple additions to this standard procedure that could deliver daycase TURP/ TURiS more reliably for all?

Why Daycase?

Only a small proportion of men with BPH symptoms will require surgery, but, despite this, Transurethral Resection of the Prostate (TURP) operations took place 18,362 times in 2016/17. This makes TURP one of the most commonly performed operations in the UK. With more than 2 post operative nights in hospital, this translates to significant bed occupancy, which is not only expensive, but also creates problems for hospitals with bed shortages.

A recent UK economic analysis indicated that increased delivery of Greenlight laser photoselective vaporisation of the prostate (PVP) could save around £204 per patient compared to TURP operations. If around 70% of these cases can be handled in just one day, the saving to the NHS could be around £3.2 million a year.

Such analysis has led to encouragement through Get It Right First Time (GIRFT) for more departments across the UK to adopt this technology. However, adoption has been slow with many urologists feeling that the much more established TURP operation allows them to deliver a safe, predictably effective and reliably performed operation that is familiar to them and their team.

Alternative approaches

Rather than push urologists to adopt unfamiliar technology and procedures such as PVP to achieve the target 70% of prostatectomy for BPH as daycase, we ask the question whether simple manoeuvres could create a scenario where TURP/ TURiS could be performed in unselected patients on a similar basis and thus achieve the aims of efficiency and money saving as encouraged through GIRFT.

The Research Proposal

My TUF funded research is looking at the introduction of including two cheap manoeuvers within the TURiS operation so that it can lead to a marked reduction in hospital stays amongst patients.

The first manoeuver is the use of a bespoke catheter tensioning device (CTD) and the second is the use of tranexamic acid (TXA).

In using TUF funding to research the impact of these two additions to the TURiS procedure on a group of 60 patients, I am hoping to make the case for a standardised approach that could achieve the required high rates of daycase surgery in a predictable and above all safe environment.

Surgery for BPH is a ‘bread and butter’ operation for urologists, to see it change from being an operation that requires multiple days in hospital to a daycase operation would be a big shift that could make a big difference to patients, families, and the NHS.

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